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assessed. This probability will depend on answers to such questions as:
a) Is there a history of similar occurrences, or is this an isolated occurrence?
b) What other equipment or components of the same type might have similar defects?
c) How many operating or maintenance personnel are following, or are subject to, the procedures in
question?
d) What percentage of the time is the suspect equipment or the questionable procedure in use?
e) To what extent are there organizational, management or regulatory implications that might reflect
larger threats to public safety?
6.3.10 Based on these considerations, the likelihood of an event occurring can be assessed, for
example, as:
a) Unlikely to occur. Failures that are “unlikely to occur” include isolated occurrences, and risks
where the exposure rate is very low or the sample size is small. The complexity of the
circumstances necessary to create an accident situation may be such that it is unlikely the same
chain of events will happen again. For example, it is unlikely that independent systems would fail
concurrently. However, even if the possibility is only remote, the consequences of concurrent
failures may warrant follow-up.
Note.— There is a natural tendency to attribute unlikely events to “coincidence”. Caution is
advised. While coincidence may be statistically feasible, coincidence should not be used as an
excuse for the absence of due analysis.
b) May occur. Failures that “may occur” derive from hazards with a reasonable probability that similar
patterns of human performance can be expected under similar working conditions, or that the same
material defects exist elsewhere in the system.
c) Probably will occur. Such occurrences reflect a pattern (or potential pattern) of material failures
that have not yet been rectified. Given the design or maintenance of the equipment, its strength
under known operating conditions, etc., continued operations will likely lead to failure. Similarly,
given the empirical evidence on some aspects of human performance, it can be expected with some
certainty that normal individuals operating under similar working conditions would likely commit the
same errors or be subject to the same undesirable performance outcome.
Severity of the consequences of occurrence
6.3.11 Having determined the probability of occurrence, the nature of the adverse consequences if the
event does occur must be assessed. The potential consequences govern the degree of urgency attached to
the safety action required. If there is significant risk of catastrophic consequences, or if the risk of serious
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injury, property or environmental damage is high, urgent follow-up action is warranted. In assessing the
severity of the consequences of occurrence, the following types of questions could apply:
a) How many lives are at risk? (Employees, passengers, bystanders and the general public.)
b) What is the likely extent of property or financial damage? (Direct property loss to the operator,
damage to aviation infrastructure, third party collateral damage, financial impact and economic
impact for the State.)
c) What is the likelihood of environmental impact? (Spill of fuel or other hazardous product, and
physical disruption of natural habitat.)
d) What are the likely political implications and/or media interest?
Risk acceptability
6.3.12 Based on the risk assessment, the risks can be prioritized relative to other, unresolved safety
hazards. This is critical in making rational decisions to allocate limited resources against those hazards
posing the greatest risks to the organization.
6.3.13 Prioritizing risks requires a rational basis for ranking one risk vis-à-vis other risks. Criteria or
standards are required to define what is an acceptable risk and what is an unacceptable risk. By weighing
the likelihood of an undesirable outcome against the potential severity of that outcome, the risk can be
categorized within a risk assessment matrix. Many versions of risk assessment matrices are available from
literature. While the terminology or definitions used for the different categories may vary, such tables
generally reflect the ideas summarized in Table 6-1.
6.3.14 In this version of a risk assessment matrix:
a) Severity of risk is ranked as Catastrophic, Hazardous, Major, Minor or Negligible with a descriptor
for each indicating the potential severity of consequences. As mentioned in 6.3.13, other definitions
can be used, reflecting the nature of the operation being analysed.
b) Probability (or likelihood) of occurrence is also ranked through five different levels of qualitative
definitions, and descriptors are provided for each likelihood of occurrence.
　
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